Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Appendix Q: Health economic evidence –
completed checklists
Q.1 Psychological and psychosocial interventions to prevent, treat and manage
mental health problems in people with learning disabilities ..................................... 2
Q.1.1
Psychological interventions aimed at reducing and managing mental
health problems in people with learning disabilities ................................................. 2
Q.2 Other interventions to prevent, treat and manage mental health problems in
people with learning disabilities.................................................................................. 6
Q.2.1
Annual health checks aimed at preventing mental health problems in
people with learning disabilities.................................................................................. 6
Abbreviations
A&E
BAI-Y
BDI-Y
CBLD
HRQoL
HUI3
N
NA
NHS
NICE
PSS
QALY
RCT
SG
Accident and Emergency
Beck Anxiety Inventory-Youth
Beck Depression Inventory-Youth
Challenging behaviour and learning disabilities
health-related quality of life
health utility index 3
number of participants
not applicable
National Health Service
National Institute for Health and Care Excellence
Personal Social Services
quality adjusted life year
randomised controlled trial
standard gamble
Mental health problems and learning disabilities
1
Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Q.1 Psychological and psychosocial interventions to prevent,
treat and manage mental health problems in people with
learning disabilities
Q.1.1
Psychological interventions aimed at reducing and managing mental health
problems in people with learning disabilities
Study: NICE guideline. Challenging behaviour and learning disabilities: Prevention
and interventions for people with learning disabilities whose behaviour challenges
(2015) Guideline primary economic analysis assessing parent training for the
management of behaviour that challenges in children and young people with learning
disabilities
Economic Question: psychological interventions (parent training) versus treatment as
usual for children and young people with learning disabilities and mental health
problems
Section 1: Applicability (relevance to specific review
question and the NICE reference case)
Yes/ Partly/
No/Unclear/
NA
Comments
1.1
Is the study population appropriate for the review
question?
Partly
Children and
young
people with
learning
disabilities &
behaviour
that
challenges
1.2
Are the interventions appropriate for the review
question?
Yes
1.3
Is the system in which the study was conducted
sufficiently similar to the current UK context?
Yes
UK study
1.4
Are the perspectives clearly stated and are they
appropriate for the review question?
Yes
NHS and
PSS
perspective
1.5
Are all direct effects on individuals included, and are
all other effects included where they are material?
Yes
1.6
Are all future costs and outcomes discounted
appropriately?
NA
Time horizon
61 weeks
1.7
Is QALY used as an outcome, and was it derived
using NICE’s preferred methods? If not, describe
rationale and outcomes used in line with analytical
perspectives taken (item 1.4 above).
Partly
HRQoL
ratings
obtained for
children with
autism
(parents
used as
proxies)
using HUI3,
with
valuations
elicited from
the Canadian
population
using SG
1.8
Are costs and outcomes from other sectors fully and
appropriately measured and valued?
NA
Mental health problems and learning disabilities
2
Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Study: NICE guideline. Challenging behaviour and learning disabilities: Prevention
and interventions for people with learning disabilities whose behaviour challenges
(2015) Guideline primary economic analysis assessing parent training for the
management of behaviour that challenges in children and young people with learning
disabilities
1.9 Overall judgement: Partially applicable
Other comments: comparator was wait list
Section 2: Study limitations (level of methodological
quality)
Yes/ Partly/
No/Unclear/
NA
Comments
2.1
Does the model structure adequately reflect the
nature of the topic under evaluation?
Yes
2.2
Is the time horizon sufficiently long to reflect all
important differences in costs and outcomes?
Partly
2.3
Are all important and relevant outcomes included?
Yes
2.4
Are the estimates of baseline outcomes from the best
available source?
Partly
CBLD
guideline
metaanalysis
2.5
Are the estimates of relative intervention effects from
the best available source?
Yes
CBLD
guideline
metaanalysis
2.6
Are all important and relevant costs included?
Partly
Costs
associated
with mental
health
problems not
included
2.7
Are the estimates of resource use from the best
available source?
Partly
RCTreported data
&
assumptions
2.8
Are the unit costs of resources from the best available
source?
Yes
National
sources
2.9
Is an appropriate incremental analysis presented or
can it be calculated from the data?
Yes
2.10
Are all important parameters whose values are
uncertain subjected to appropriate sensitivity
analysis?
Yes
2.11
Is there any potential conflict of interest?
No
61 weeks
PSA and
one-way
sensitivity
analysis
conducted
2.12 Overall assessment: potentially serious limitations
Other comments: probability of relapse based on assumption due to lack of evidence
Mental health problems and learning disabilities
3
Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Study: Hassiotis A, Serfaty M, Azam K, Strydom A, Blizard R, Romeo R, Martin S, King
M (2013) Manualised Individual Cognitive Behavioural Therapy for mood disorders in
people with mild to moderate intellectual disability: A feasibility randomised
controlled trial. Journal of Affective Disorders 151, 186-195.
Economic Question: psychological interventions versus treatment as usual for adults
with learning disabilities and mental health problems
Section 1: Applicability (relevance to specific review
question and the NICE reference case)
Yes/ Partly/
No/Unclear/
NA
Comments
1.1
Is the study population appropriate for the review
question?
Yes
Adults with
mild to
moderate
learning
disability and
a mood
disorder or
symptoms of
depression
and /or
anxiety
1.2
Are the interventions appropriate for the review
question?
Yes
1.3
Is the system in which the study was conducted
sufficiently similar to the current UK context?
Yes
UK study
1.4
Are the perspectives clearly stated and are they
appropriate for the review question?
Yes
NHS and
social care
perspective
1.5
Are all direct effects on individuals included, and are
all other effects included where they are material?
Yes
1.6
Are all future costs and outcomes discounted
appropriately?
NA
Time horizon
16 weeks
1.7
Is QALY used as an outcome, and was it derived
using NICE’s preferred methods? If not, describe
rationale and outcomes used in line with analytical
perspectives taken (item 1.4 above).
No
Depression &
anxiety
symptom
scales used,
relevant to
objective of
intervention
1.8
Are costs and outcomes from other sectors fully and
appropriately measured and valued?
NA
1.9 Overall judgement: Partially applicable
Other comments: no QALYs used; intervention more effective in one of the primary
outcomes, less effective in the other; required judgement on cost effectiveness
Section 2: Study limitations (level of methodological
quality)
Yes/ Partly/
No/Unclear/
NA
Comments
2.1
Does the model structure adequately reflect the
nature of the topic under evaluation?
NA
RCT
2.2
Is the time horizon sufficiently long to reflect all
important differences in costs and outcomes?
No
16 weeks
2.3
Are all important and relevant outcomes included?
Partly
BDI-Y and
BAI-Y
changes; no
HRQoL
considered
Mental health problems and learning disabilities
4
Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Study: Hassiotis A, Serfaty M, Azam K, Strydom A, Blizard R, Romeo R, Martin S, King
M (2013) Manualised Individual Cognitive Behavioural Therapy for mood disorders in
people with mild to moderate intellectual disability: A feasibility randomised
controlled trial. Journal of Affective Disorders 151, 186-195.
2.4
Are the estimates of baseline outcomes from the best
available source?
Partly
RCT, N=32
2.5
Are the estimates of relative intervention effects from
the best available source?
Partly
Feasibility
RCT
2.6
Are all important and relevant costs included?
Yes
2.7
Are the estimates of resource use from the best
available source?
Partly
RCT, N=32
2.8
Are the unit costs of resources from the best available
source?
Yes
National
sources
2.9
Is an appropriate incremental analysis presented or
can it be calculated from the data?
Yes
2.10
Are all important parameters whose values are
uncertain subjected to appropriate sensitivity
analysis?
Partly
2.11
Is there any potential conflict of interest?
No
2.12 Overall assessment: very serious limitations
Other comments: none
Mental health problems and learning disabilities
5
Some
statistical
analysis
conducted,
but level of
significance
not reported
Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Q.2 Other interventions to prevent, treat and manage mental
health problems in people with learning disabilities
Q.2.1
Annual health checks aimed at preventing mental health problems in people
with learning disabilities
Study: Cooper S-A, Morrison J, Allan LM, McConnachie A, Greenlaw N, Melville CA,
Baltzer MC, McArthur LA, Lammie C, Martin G, Grieve EAD, Fenwick E. Practice nurse
health checks for adults with intellectual disabilities: a cluster-design, randomised
controlled trial. The Lancet Psychiatry 2014; 1(7): 511–521.
Economic Question: Health checks versus treatment as usual for adults with learning
disabilities
Section 1: Applicability (relevance to specific review
question and the NICE reference case)
Yes/ Partly/
No/Unclear/
NA
Comments
1.1
Is the study population appropriate for the review
question?
Yes
Adults with
learning
disabilities
1.2
Are the interventions appropriate for the review
question?
Yes
1.3
Is the system in which the study was conducted
sufficiently similar to the current UK context?
Yes
UK study
1.4
Are the perspectives clearly stated and are they
appropriate for the review question?
Yes
NHS
perspective
1.5
Are all direct effects on individuals included, and are
all other effects included where they are material?
Partly
Effect on
mental health
not directly
considered
1.6
Are all future costs and outcomes discounted
appropriately?
NA
Time horizon
9 months
1.7
Is QALY used as an outcome, and was it derived
using NICE’s preferred methods? If not, describe
rationale and outcomes used in line with analytical
perspectives taken (item 1.4 above).
Yes
Based on
EQ-5D
measuremen
ts using UK
tariff;
participant or
carer-rated
1.8
Are costs and outcomes from other sectors fully and
appropriately measured and valued?
NA
1.9 Overall judgement: Directly applicable
Other comments: None
Section 2: Study limitations (level of methodological
quality)
Yes/ Partly/
No/Unclear/
NA
Comments
2.1
Does the model structure adequately reflect the
nature of the topic under evaluation?
NA
RCT
2.2
Is the time horizon sufficiently long to reflect all
important differences in costs and outcomes?
No
9 months
2.3
Are all important and relevant outcomes included?
Partly
See ‘other
comments’
2.4
Are the estimates of baseline outcomes from the best
available source?
Partly
RCT, N=152
Mental health problems and learning disabilities
6
Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Study: Cooper S-A, Morrison J, Allan LM, McConnachie A, Greenlaw N, Melville CA,
Baltzer MC, McArthur LA, Lammie C, Martin G, Grieve EAD, Fenwick E. Practice nurse
health checks for adults with intellectual disabilities: a cluster-design, randomised
controlled trial. The Lancet Psychiatry 2014; 1(7): 511–521.
2.5
Are the estimates of relative intervention effects from
the best available source?
Yes
RCT
2.6
Are all important and relevant costs included?
Partly
See ‘other
comments’
2.7
Are the estimates of resource use from the best
available source?
Partly
RCT, N=152
2.8
Are the unit costs of resources from the best available
source?
Yes
National
sources
2.9
Is an appropriate incremental analysis presented or
can it be calculated from the data?
Yes
2.10
Are all important parameters whose values are
uncertain subjected to appropriate sensitivity
analysis?
Yes
2.11
Is there any potential conflict of interest?
No
2.12 Overall assessment: potentially serious limitations
Other comments: only 65 (76.5%) of the health-check group received the intervention; also
one person in the standard care group received the intervention; EQ-5D may not be directly
relevant to people with learning disabilities; some measurements were based on proxy
ratings, with different carers rating health between baseline and follow-up for some
participants; secondary care costs not considered (apart from A&E); small study sample
(N=152)
Study: Gordon LG, Holden L, Ware RS, Taylor MT, Lennox NG (2012) Comprehensive
health assessments for adults with intellectual disability living in the community weighing up the costs and benefits. Australian Family Physician 41(12), 969-972.
Economic Question: Health checks versus treatment as usual for adults with learning
disabilities
Section 1: Applicability (relevance to specific review
question and the NICE reference case)
Yes/ Partly/
No/Unclear/
NA
Comments
1.1
Is the study population appropriate for the review
question?
Yes
Adults with
learning
disabilities
1.2
Are the interventions appropriate for the review
question?
Yes
1.3
Is the system in which the study was conducted
sufficiently similar to the current UK context?
Partly
Australian
study
1.4
Are the perspectives clearly stated and are they
appropriate for the review question?
Yes
Public
healthcare
system
1.5
Are all direct effects on individuals included, and are
all other effects included where they are material?
Partly
Effect on
mental health
not
considered
Mental health problems and learning disabilities
7
Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Study: Gordon LG, Holden L, Ware RS, Taylor MT, Lennox NG (2012) Comprehensive
health assessments for adults with intellectual disability living in the community weighing up the costs and benefits. Australian Family Physician 41(12), 969-972.
1.6
Are all future costs and outcomes discounted
appropriately?
NA
Time horizon
12 months
1.7
Is QALY used as an outcome, and was it derived
using NICE’s preferred methods? If not, describe
rationale and outcomes used in line with analytical
perspectives taken (item 1.4 above).
No
Tests and
immunization
rates
measured,
relevant to
intervention
1.8
Are costs and outcomes from other sectors fully and
appropriately measured and valued?
NA
1.9 Overall judgement: Partially applicable
Other comments: None
Section 2: Study limitations (level of methodological
quality)
Yes/ Partly/
No/Unclear/
NA
Comments
2.1
Does the model structure adequately reflect the
nature of the topic under evaluation?
NA
RCT
2.2
Is the time horizon sufficiently long to reflect all
important differences in costs and outcomes?
No
12 months
2.3
Are all important and relevant outcomes included?
Partly
Tests and
immunization
rates
measured,
no HRQoL or
impact on
mental health
2.4
Are the estimates of baseline outcomes from the best
available source?
Partly
RCT, N=242
2.5
Are the estimates of relative intervention effects from
the best available source?
Yes
RCT
2.6
Are all important and relevant costs included?
Partly
See ‘other
comments’
2.7
Are the estimates of resource use from the best
available source?
Partly
RCT, N=242
2.8
Are the unit costs of resources from the best available
source?
Yes
National
sources
2.9
Is an appropriate incremental analysis presented or
can it be calculated from the data?
Yes
2.10
Are all important parameters whose values are
uncertain subjected to appropriate sensitivity
analysis?
Yes
2.11
Is there any potential conflict of interest?
No
Statistical
analysis
conducted
2.12 Overall assessment: potentially serious limitations
Other comments: some medications and vaccines were potentially excluded from costings
as they are not eligible for Pharmaceutical Benefits Scheme claims; secondary care costs
were not measured; short time horizon; one service provider included
Mental health problems and learning disabilities
8
Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Study: Romeo R, Knapp M, Morrison J, Melville C, Allan L, Finlayson J, Cooper SA
(2009) Cost estimation of a health-check intervention for adults with intellectual
disabilities in the UK. Journal of Intellectual Disability Research, 53(5), 426-39.
Economic Question: Health checks versus treatment as usual for adults with learning
disabilities
Section 1: Applicability (relevance to specific review
question and the NICE reference case)
Yes/ Partly/
No/Unclear/
NA
Comments
1.1
Is the study population appropriate for the review
question?
Yes
Adults with
learning
disabilities
1.2
Are the interventions appropriate for the review
question?
Yes
1.3
Is the system in which the study was conducted
sufficiently similar to the current UK context?
Yes
UK study
1.4
Are the perspectives clearly stated and are they
appropriate for the review question?
Partly
Societal
1.5
Are all direct effects on individuals included, and are
all other effects included where they are material?
Partly
Effect on
mental health
not
considered
1.6
Are all future costs and outcomes discounted
appropriately?
NA
Time horizon
12 months
1.7
Is QALY used as an outcome, and was it derived
using NICE’s preferred methods? If not, describe
rationale and outcomes used in line with analytical
perspectives taken (item 1.4 above).
No
Intermediate
outcomes
relating to
detected and
met health
needs
1.8
Are costs and outcomes from other sectors fully and
appropriately measured and valued?
NA
1.9 Overall judgement: Partially applicable
Other comments: no QALYs estimated but intervention dominant, so no further judgments
required to assess cost effectiveness
Section 2: Study limitations (level of methodological
quality)
Yes/ Partly/
No/Unclear/
NA
Comments
2.1
Does the model structure adequately reflect the
nature of the topic under evaluation?
NA
Cohort study
with matched
controls
2.2
Is the time horizon sufficiently long to reflect all
important differences in costs and outcomes?
No
12 months
2.3
Are all important and relevant outcomes included?
Partly
Intermediate
outcomes
relating to
detected and
met health
needs;
impact on
mental health
or HRQoL
not
considered
2.4
Are the estimates of baseline outcomes from the best
available source?
Partly
Cohort study
with matched
Mental health problems and learning disabilities
9
Mental health problems in people with learning disabilities
Appendix Q: Health economic evidence – completed checklists
Study: Romeo R, Knapp M, Morrison J, Melville C, Allan L, Finlayson J, Cooper SA
(2009) Cost estimation of a health-check intervention for adults with intellectual
disabilities in the UK. Journal of Intellectual Disability Research, 53(5), 426-39.
controls,
N=100
2.5
Are the estimates of relative intervention effects from
the best available source?
Partly
Cohort study
with matched
controls
2.6
Are all important and relevant costs included?
Yes
2.7
Are the estimates of resource use from the best
available source?
Partly
Cohort study
with matched
controls, see
‘other
comments’
2.8
Are the unit costs of resources from the best available
source?
Yes
National
sources &
further
estimates
2.9
Is an appropriate incremental analysis presented or
can it be calculated from the data?
NA
Cost
consequence
analysis
2.10
Are all important parameters whose values are
uncertain subjected to appropriate sensitivity
analysis?
Yes
Statistical
analyses
conducted
2.11
Is there any potential conflict of interest?
No
2.12 Overall assessment: potentially serious limitations
Other comments: Participants matched with controls for age, gender and level of learning
disability; costs collected prospectively for intervention group and retrospectively for control
group; small study sample (N=100)
Mental health problems and learning disabilities
10